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Fayed I, Syed M, Gingold E, Alizadeh M, Sharan A, Wu C. A Novel and Simple Method Using Computed Tomography Streak Artifact to Determine the Orientation of Directional Deep Brain Stimulation Leads. Neurosurgery 2023; 93:1036-1045. [PMID: 37227135 DOI: 10.1227/neu.0000000000002536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Directional leads have garnered widespread use in deep brain stimulation (DBS) because of the ability to steer current and maximize the therapeutic window. Accurate identification of lead orientation is critical to effective programming. Although directional markers are visible on 2-dimensional imaging, precise orientation may be difficult to interpret. Recent studies have suggested methods of determining lead orientation, but these involve advanced intraoperative imaging and/or complex computational algorithms. Our objective is to develop a precise and reliable method of determining orientation of directional leads using conventional imaging techniques and readily available software. METHODS We examined postoperative thin-cut computed tomography (CT) scans and x-rays of patients who underwent DBS with directional leads from 3 vendors. Using commercially available stereotactic software, we localized the leads and planned new trajectories precisely overlaying the leads visualized on CT. We used trajectory view to locate the directional marker in a plane orthogonal to the lead and inspected the streak artifact. We then validated this method with a phantom CT model by acquiring thin-cut CT images orthogonal to 3 different leads in various orientations confirmed under direct visualization. RESULTS The directional marker creates a unique streak artifact that reflects the orientation of the directional lead. There is a hyperdense symmetric streak artifact parallel to the axis of the directional marker and a symmetric hypodense dark band orthogonal to the marker. This is often sufficient to infer the direction of the marker. If not, it at least renders 2 opposite possibilities for the direction of the marker, which can then be easily reconciled by comparison with x-ray images. CONCLUSION We propose a method to determine orientation of directional DBS leads in a precise manner on conventional imaging and readily available software. This method is reliable across DBS vendors, and it can simplify this process and aid in effective programming.
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Affiliation(s)
- Islam Fayed
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Mashaal Syed
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Eric Gingold
- Department of Radiology, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Mahdi Alizadeh
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
- Department of Radiology, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Ashwini Sharan
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Chengyuan Wu
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
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Frassica M, Kern DS, Afshari M, Connolly AT, Wu C, Rowland N, Ramirez-Castaneda J, Ushe M, Salazar C, Mason X. Racial disparities in access to DBS: results of a real-world U.S. claims data analysis. Front Neurol 2023; 14:1233684. [PMID: 37602243 PMCID: PMC10433186 DOI: 10.3389/fneur.2023.1233684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) is an effective and standard-of-care therapy for Parkinson's Disease and other movement disorders when symptoms are inadequately controlled with conventional medications. It requires expert care for patient selection, surgical targeting, and therapy titration. Despite the known benefits, racial/ethnic disparities in access have been reported. Technological advancements with smartphone-enabled devices may influence racial disparities. Real-world evidence investigations can shed further light on barriers to access and demographic disparities for DBS patients. Methods A retrospective cross-sectional study was performed using Medicare claims linked with manufacturer patient data tracking to analyze 3,869 patients who received DBS. Patients were divided into two categories: traditional omnidirectional DBS systems with dedicated proprietary controllers ("traditional"; n = 3,256) and directional DBS systems with smart controllers ("smartphone-enabled"; n = 613). Demographics including age, sex, and self-identified race/ethnicity were compared. Categorical demographics, including race/ethnicity and distance from implanting facility, were analyzed for the entire population. Results A significant disparity in DBS utilization was evident. White individuals comprised 91.4 and 89.9% of traditional and smartphone-enabled DBS groups, respectively. Non-White patients were significantly more likely to live closer to implanting facilities compared with White patients. Conclusion There is great racial disparity in utilization of DBS therapy. Smartphone-enabled systems did not significantly impact racial disparities in receiving DBS. Minoritized patients were more likely to live closer to their implanting facility than White patients. Further research is warranted to identify barriers to access for minoritized patients to receive DBS. Technological advancements should consider the racial discrepancy of DBS utilization in future developments.
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Affiliation(s)
| | - Drew S. Kern
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mitra Afshari
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | | | - Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nathan Rowland
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Juan Ramirez-Castaneda
- Methodist Physicians, Neurosurgery and Neurology Specialists, San Antonio, TX, United States
| | - Mwiza Ushe
- Department of Neurology, Washington University, St. Louis, MO, United States
| | - Claudia Salazar
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Xenos Mason
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
- Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
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Dipietro L, Gonzalez-Mego P, Ramos-Estebanez C, Zukowski LH, Mikkilineni R, Rushmore RJ, Wagner T. The evolution of Big Data in neuroscience and neurology. JOURNAL OF BIG DATA 2023; 10:116. [PMID: 37441339 PMCID: PMC10333390 DOI: 10.1186/s40537-023-00751-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/08/2023] [Indexed: 07/15/2023]
Abstract
Neurological diseases are on the rise worldwide, leading to increased healthcare costs and diminished quality of life in patients. In recent years, Big Data has started to transform the fields of Neuroscience and Neurology. Scientists and clinicians are collaborating in global alliances, combining diverse datasets on a massive scale, and solving complex computational problems that demand the utilization of increasingly powerful computational resources. This Big Data revolution is opening new avenues for developing innovative treatments for neurological diseases. Our paper surveys Big Data's impact on neurological patient care, as exemplified through work done in a comprehensive selection of areas, including Connectomics, Alzheimer's Disease, Stroke, Depression, Parkinson's Disease, Pain, and Addiction (e.g., Opioid Use Disorder). We present an overview of research and the methodologies utilizing Big Data in each area, as well as their current limitations and technical challenges. Despite the potential benefits, the full potential of Big Data in these fields currently remains unrealized. We close with recommendations for future research aimed at optimizing the use of Big Data in Neuroscience and Neurology for improved patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s40537-023-00751-2.
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Affiliation(s)
| | - Paola Gonzalez-Mego
- Spaulding Rehabilitation/Neuromodulation Lab, Harvard Medical School, Cambridge, MA USA
| | | | | | | | | | - Timothy Wagner
- Highland Instruments, Cambridge, MA USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA USA
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Koivu M, Scheperjans F, Eerola-Rautio J, Vartiainen N, Resendiz-Nieves J, Kivisaari R, Pekkonen E. Real-Life Experience on Directional Deep Brain Stimulation in Patients with Advanced Parkinson’s Disease. J Pers Med 2022; 12:jpm12081224. [PMID: 36013173 PMCID: PMC9410362 DOI: 10.3390/jpm12081224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/29/2022] Open
Abstract
Directional deep brain stimulation (dDBS) is preferred by patients with advanced Parkinson’s disease (PD) and by programming neurologists. However, real-life data of dDBS use is still scarce. We reviewed the clinical data of 53 PD patients with dDBS to 18 months of follow-up. Directional stimulation was favored in 70.5% of dDBS leads, and single segment activation (SSA) was used in 60% of dDBS leads. Current with SSA was significantly lower than with other stimulation types. During the 6-month follow-up, a 44% improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS-III) points and a 43% decline in the levodopa equivalent daily dosage (LEDD) was observed. After 18 months of follow-up, a 35% LEDD decrease was still noted. The Hoehn and Yahr (H&Y) stages and scores on item no 30 “postural stability” in UPDRS-III remained lower throughout the follow-up compared to baseline. Additionally, dDBS relieved non-motor symptoms during the 6 months of follow-up. Patients with bilateral SSA had similar clinical outcomes to those with other stimulation types. Directional stimulation appears to effectively reduce both motor and non-motor symptoms in advanced PD with minimal adverse effects in real-life clinical care.
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Affiliation(s)
- Maija Koivu
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, PL 00029 Helsinki, Finland; (F.S.); (J.E.-R.); (E.P.)
- Correspondence:
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, PL 00029 Helsinki, Finland; (F.S.); (J.E.-R.); (E.P.)
| | - Johanna Eerola-Rautio
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, PL 00029 Helsinki, Finland; (F.S.); (J.E.-R.); (E.P.)
| | - Nuutti Vartiainen
- Department of Neurosurgery, Helsinki University Hospital, PL 00029 Helsinki, Finland; (N.V.); (J.R.-N.); (R.K.)
| | - Julio Resendiz-Nieves
- Department of Neurosurgery, Helsinki University Hospital, PL 00029 Helsinki, Finland; (N.V.); (J.R.-N.); (R.K.)
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Hospital, PL 00029 Helsinki, Finland; (N.V.); (J.R.-N.); (R.K.)
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, PL 00029 Helsinki, Finland; (F.S.); (J.E.-R.); (E.P.)
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